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Rehabilitation Election BWC-7208 - Ohio
|Rehabilitation Election Form. This is a Ohio form and can be used in Employers Workers Comp .||
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Better Workers' Compensation Built with you in mind. The Ohio Bureau of Workers' Compensation 30 West Spring Street, Columbus, Ohio 43215-2256 Dear Self-insured applicant: Effective October 20, 1993, self-insuring employers may elect to pay rehabilitation costs directly in accordance with Revised Code §4121.66 as amended by Am. Sub. H.B. 107. Employers exercising the option will no longer be assessed the portion of the surplus fund assessments for rehabilitation costs, although self-insuring employers will be responsible for any deficit amount in such assessments calculated pursuant to the provisions of Revised Code §4123.34 (B) as amended by Am. Sub. H. 107. If your company elects to pay rehabilitation cost directly, the election will become effective upon approval of selfinsurance. If your company elects to pay rehabilitation costs directly, please complete the bottom portion of this letter and return to the Self-Insurance Department at the address above. THIS ELECTION IS IRREVOCABLE BWC USE ONLY Applicant number I hereby elect to pay rehabilitation costs directly, in accordance with the provisions of §4121.66 as amended by Am. Sub. H.B. 107 I certify that I am empowered to make this election on behalf of (Company name) Signature Title Date BWC-7208 (Rev. 10/9/1997) SI-8 2002 © American LegalNet, Inc.